Radiation therapy is often part of a cancer patient’s treatment. It’s typically not painful, unless you consider the time burden it places on patients to be a pain.

Conventional cancer radiation treatment is given in doses every weekday for five to seven weeks. That means a patient will make between 25 and 35 trips to the hospital or radiation clinic. That’s a huge commitment even for people who have their own transportation. For patients who don’t have a car, there’s an added logistical layer to navigate.

That’s why, for patients who qualify, stereotactic body radiation therapy (SBRT) is a game changer. It involves higher doses of radiation given over a condensed period — between one and five days.

“The treatment isn’t new, but we’ve gotten more and more data to support it over the years. So, it’s gaining in popularity,” said Dr. Jimmy Broughman, a radiation oncologist who cares for patients at Novant Health Coastal Carolina Radiation Oncology - Wilmington. “A lot of patients don't know it’s an option. When I tell a patient, ‘We can do this in just five days,’ their jaw drops.”

Here Broughman shares more about stereotactic body radiation therapy (SBRT), what cancers SBRT can treat and how it compares to conventional radiation for cancer treatment.

What is SBRT?

​Stereotactic body radiation therapy is basically an advanced form of external-beam radiation therapy. It gives big doses of radiation per day, allowing us to complete the course of radiation over a much shorter time period. Instead of giving a little bit of radiation Mondays through Fridays for five to seven weeks, we deliver all the radiation a patient needs within just one to five days. It’s becoming better known because of advances in technology and the robust data we have showing its effectiveness.

Does SBRT come with the same side effects, like radiation burns, as conventional radiation for cancer treatment?

The side effects of radiation have to do with the area we’re treating.

Treating prostate cancer will give you a certain set of side effects, usually due to irritation of nearby structures like the bladder or rectum. There could be a temporary increase in urinary tract irritation, similar to what you’d feel with a urinary tract infection.

But treating lung cancer might cause inflammation of the lung tissue surrounding the tumor, which could make you feel like you have a cough or temporary shortness of breath.

For most people, any side effects are very well tolerated. It’s very unlikely we’d need to discontinue radiation, since once you start, you want to deliver all of it as prescribed. If you don’t get the full dosage, the radiation might not work quite as well.

When comparing SBRT to conventional radiation, there’s no meaningful difference in the side effects. The area of tissue we're treating is very small, and that keeps the side effects to a minimum.

Is SBRT appropriate for every kind of cancer?

SBRT is used most often for prostate cancer, early-stage lung cancer, liver cancer and brain metastases. We use it in situations where the cancer is confined to a small area.

If you had prostate cancer that spread to lymph nodes, SBRT would probably not be the right way to go. You’d want conventional radiation because you’re treating a bigger volume of tissue, and you’d want a gentler approach and a smaller daily dose.

Does SBRT yield better outcomes than traditional radiation, or is it purely for convenience?

In cases where we're able to give very high doses to a very small area — like with brain tumors — the control rates are actually better than what you’d get from conventional radiation. But an added benefit is the convenience factor.

With SBRT, are patients still outfitted for a mold, as in conventional radiation for cancer treatment?

It is basically the same experience. But with SBRT, we will sometimes use other fancy techniques like motion management. With lung cancer, for example, the tumor moves up and down as the patient is breathing. SBRT lets us take measures to ensure the radiation is tracking the tumor as it moves.

How do you help patients determine if SBRT is a good option for them?

For early-stage lung cancer patients who aren’t having surgery, we offer them SBRT without even thinking about conventional external-beam radiation.

But for prostate cancer, there are certain patients we would offer a choice. The reason we might pick the 28 days over five days is because a man with prostate cancer is probably going to have some side effects from radiation, like bladder or bowel irritation. And if he has a lot of preexisting bladder issues, then he may tolerate the slower course of radiation better.

Can SBRT be used for breast cancer that has not spread?

No, but there is an exciting new treatment option for eligible women called accelerated partial breast irradiation (APBI) that similarly delivers larger doses of radiation over just five days to the tumor bed (the area from which the tumor was removed) after surgery. See the sidebar below for more on this.

Is SBRT widely available, and could it eventually be used to treat more types of cancer?

SBRT is becoming more widely available, but it’s not offered at every cancer center. All seven radiation oncologists at Novant Health Coastal Carolina Radiation Oncology - Wilmington are trained to perform SBRT, and we use it frequently. Smaller cancer centers may not yet have the technology or expertise to offer it.

As radiation oncologists, we’re always looking for ways to make cancer treatment easier and more convenient for patients, including finding ways to shorten the number of treatments. I could definitely see SBRT expanding to treat additional types of cancer as we learn more about how to use it safely and effectively.